Abstract

Background Governments worldwide recommend daily consumption of fruit and vegetables. We examine whether this benefits health in the
general population of England.

Methods Cox regression was used to estimate HRs and 95% CI for an association between fruit and vegetable consumption and all-cause,
cancer and cardiovascular mortality, adjusting for age, sex, social class, education, BMI, alcohol consumption and physical
activity, in 65 226 participants aged 35+ years in the 2001–2008 Health Surveys for England, annual surveys of nationally
representative random samples of the non-institutionalised population of England linked to mortality data (median follow-up:
7.7 years).

Results Fruit and vegetable consumption was associated with decreased all-cause mortality (adjusted HR for 7+ portions 0.67 (95%
CI 0.58 to 0.78), reference category <1 portion). This association was more pronounced when excluding deaths within a year
of baseline (0.58 (0.46 to 0.71)). Fruit and vegetable consumption was associated with reduced cancer (0.75 (0.59–0.96)) and
cardiovascular mortality (0.69 (0.53 to 0.88)). Vegetables may have a stronger association with mortality than fruit (HR for
2 to 3 portions 0.81 (0.73 to 0.89) and 0.90 (0.82 to 0.98), respectively). Consumption of vegetables (0.85 (0.81 to 0.89)
per portion) or salad (0.87 (0.82 to 0.92) per portion) were most protective, while frozen/canned fruit consumption was apparently
associated with increased mortality (1.17 (1.07 to 1.28) per portion).

Conclusions A robust inverse association exists between fruit and vegetable consumption and mortality, with benefits seen in up to 7+
portions daily. Further investigations into the effects of different types of fruit and vegetables are warranted.

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